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Vargo M, Aldrich M, Donahue P, Iker E, Koelmeyer L, Crescenzi R, Cheville A. Current diagnostic and quantitative techniques in the field of lymphedema management: a critical review. Med Oncol 2024; 41:241. [PMID: 39235664 PMCID: PMC11377676 DOI: 10.1007/s12032-024-02472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/02/2024] [Indexed: 09/06/2024]
Abstract
Lymphedema evaluation entails multifaceted considerations for which options continue to evolve and emerge. This paper provides a critical review of the current status of diagnostic and quantitative measures for lymphedema, from traditional and novel bedside assessment tools for volumetric and fluid assessment, to advanced imaging modalities. Modalities are contrasted with regard to empirical support and feasibility of clinical implementation. The manuscript proposes a grid framework for comparing the ability of each modality to quantify specific lymphedema characteristics, including distribution, dysmorphism, tissue composition and fluid content, lymphatic anatomy and function, metaplasia, clinical symptoms, and quality of life and function. This review additionally applies a similar framework approach to consider how well assessment tools support important clinical needs, including: (1) screening, (2) diagnosis and differential diagnosis, (3) individualization of treatment, and (4) monitoring treatment response. The framework highlights which clinical needs are served by an abundance of assessment tools and identifies others that have problematically few. The framework clarifies which tools have greater or lesser empirical support. The framework is designed to assist stakeholders in selecting appropriate diagnostic and surveillance modalities, gauging levels of confidence when applying tools to specific clinical needs, elucidating overarching patterns of diagnostic and quantitative strengths and weaknesses, and informing future investigation.
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Affiliation(s)
- Mary Vargo
- Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute, Case Western Reserve University, Cleveland, OH, USA
| | | | - Paula Donahue
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Iker
- Lymphedema Center, Santa Monica, CA, USA
| | - Louise Koelmeyer
- Australian Lymphoedema Education, Research & Treatment (ALERT) Program, Macquarie University, Sydney, Australia.
| | - Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Tjalma WAA, Belgrado JP, Thomis S, Nevelsteen I, Gebruers N, Monten C, Hanssens M, De Vrieze T, Devoogdt N. Reply to Bourgeois, P. Comment on "Devoogdt et al. The Effectiveness of Fluoroscopy-Guided Manual Lymph Drainage as Part of Decongestive Lymphatic Therapy on the Superficial Lymphatic Architecture in Patients with Breast Cancer-Related Lymphoedema: A Randomised Controlled Trial. Cancers 2023, 15, 1545". Cancers (Basel) 2024; 16:2435. [PMID: 39001497 PMCID: PMC11240713 DOI: 10.3390/cancers16132435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
We appreciate the commentary by Pierre Bourgeois [...].
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Affiliation(s)
- Wiebren A. A. Tjalma
- Multidisciplinary Breast Clinic and Multidisciplinary Oedema Clinic, Antwerp University Hospital, 2650 Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, MIPRO, 2610 Antwerp, Belgium
| | - Jean-Paul Belgrado
- Lymphology Research Unit, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
| | - Nick Gebruers
- Multidisciplinary Breast Clinic and Multidisciplinary Oedema Clinic, Antwerp University Hospital, 2650 Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, 2610 Antwerp, Belgium
| | - Chris Monten
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marianne Hanssens
- Department of Oncology, Centre for Oncology, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, 2610 Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Nele Devoogdt
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
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Fowler JWM, Song L, Tam K, Roth Flach RJ. Targeting lymphatic function in cardiovascular-kidney-metabolic syndrome: preclinical methods to analyze lymphatic function and therapeutic opportunities. Front Cardiovasc Med 2024; 11:1412857. [PMID: 38915742 PMCID: PMC11194411 DOI: 10.3389/fcvm.2024.1412857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
The lymphatic vascular system spans nearly every organ in the body and serves as an important network that maintains fluid, metabolite, and immune cell homeostasis. Recently, there has been a growing interest in the role of lymphatic biology in chronic disorders outside the realm of lymphatic abnormalities, lymphedema, or oncology, such as cardiovascular-kidney-metabolic syndrome (CKM). We propose that enhancing lymphatic function pharmacologically may be a novel and effective way to improve quality of life in patients with CKM syndrome by engaging multiple pathologies at once throughout the body. Several promising therapeutic targets that enhance lymphatic function have already been reported and may have clinical benefit. However, much remains unclear of the discreet ways the lymphatic vasculature interacts with CKM pathogenesis, and translation of these therapeutic targets to clinical development is challenging. Thus, the field must improve characterization of lymphatic function in preclinical mouse models of CKM syndrome to better understand molecular mechanisms of disease and uncover effective therapies.
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Affiliation(s)
| | | | | | - Rachel J. Roth Flach
- Internal Medicine Research Unit, Pfizer Research and Development, Cambridge, MA, United States
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Yates J. Use of simple lymphatic drainage on truncal lymphoedema for a patient with diabetes and peripheral arterial disease. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:100-103. [PMID: 38335097 DOI: 10.12968/bjon.2024.33.3.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Lymphoedema is the gradual, abnormal build-up of lymph fluid in the tissues resulting from a failure of the lymphatic system. The swelling impedes movement and is painful. Compression garments are contraindicated and not tolerated by patients with extensive peripheral arterial disease. In this case study, simple lymphatic drainage was therefore considered a safer treatment option to reduce oedema and to encourage proactive self-management for a patient with bilateral amputations, diabetes and peripheral arterial disease.
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Affiliation(s)
- Jennifer Yates
- Vascular and Lymphoedema Nurse Specialist, Sheffield Teaching Hospitals
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Nagy BI, Mohos B, Tzou CHJ. Imaging Modalities for Evaluating Lymphedema. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2016. [PMID: 38004065 PMCID: PMC10673374 DOI: 10.3390/medicina59112016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Lymphedema is a progressive condition. Its therapy aims to reduce edema, prevent its progression, and provide psychosocial aid. Nonsurgical treatment in advanced stages is mostly insufficient. Therefore-in many cases-surgical procedures, such as to restore lymph flow or excise lymphedema tissues, are the only ways to improve patients' quality of life. Imaging modalities: Lymphoscintigraphy (LS), near-infrared fluorescent (NIRF) imaging-also termed indocyanine green (ICG) lymphography (ICG-L)-ultrasonography (US), magnetic resonance lymphangiography (MRL), computed tomography (CT), photoacoustic imaging (PAI), and optical coherence tomography (OCT) are standardized techniques, which can be utilized in lymphedema diagnosis, staging, treatment, and follow-up. Conclusions: The combined use of these imaging modalities and self-assessment questionnaires deliver objective parameters for choosing the most suitable surgical therapy and achieving the best possible postoperative outcome.
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Affiliation(s)
- Bendeguz Istvan Nagy
- Department of Thoracic, Cardiac and Vascular Surgery, Westpfalz-Klinikum GmbH, 67655 Kaiserslautern, Germany
| | - Balazs Mohos
- Heart and Vascular Center, Semmelweis University, 1094 Budapest, Hungary
- Plastic and Reconstructive Surgery, Department of Surgery, County Hospital Veszprem, 8200 Veszprem, Hungary
- Balaton Private Clinic, 8200 Veszprem, Hungary
| | - Chieh-Han John Tzou
- Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, 1060 Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria
- Lymphedema Center Vienna, TZOU MEDICAL., 1060 Vienna, Austria
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Duygu-Yildiz E, Bakar Y, Hizal M. The effect of complex decongestive physiotherapy applied with different compression pressures on skin and subcutaneous tissue thickness in individuals with breast cancer-related lymphedema: a double-blinded randomized comparison trial. Support Care Cancer 2023; 31:383. [PMID: 37285046 DOI: 10.1007/s00520-023-07843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effect of compression bandage applied with different pressures on the skin and subcutaneous thickness in individuals with breast cancer-related lymphedema (BCRL). METHODS 21 individuals with stage 2 unilateral BCRL participated in the study. Individuals were randomly allocated into two groups as low-pressure bandage (20-30 mmHg) (n: 11) and high-pressure bandage (45-55 mmHg) (n: 10). Skin and subcutaneous tissue thickness, extremity volume, sleep quality, treatment benefit, and comfort were evaluated by ultrasound from 6 reference points (as hand dorsum, wrist volar, forearm volar, arm volar, forearm dorsum, and arm dorsum), volumetric measurement, Pittsburgh Sleep Quality Index, Patient Benefit Index-Lymphedema, and visual analog scale, respectively. Complex decongestive physiotherapy was applied to both groups. Compression bandage was applied according to their group. Individuals were evaluated at the baseline, 1st session, 10th session, 20th session, and at 3-month follow-up. RESULTS Skin thickness decreased significantly in the volar reference points of the extremity in the high-pressure bandage group (p = 0.004, p = 0.031, and p = 0.003). Subcutaneous tissue thickness significantly decreased at all reference points in the high-pressure bandage group (p < 0.05). In the low-pressure bandage group, skin thickness only decreased in the forearm dorsum and the arm dorsum (p = 0.002, p = 0.035) and subcutaneous tissue thickness changed for all points (p < 0.05) except for hand and arm dorsum (p = 0.064, p = 0.236). Edema decreased in a shorter time in the high-pressure bandage group (p < 0.001). No significant differences were found in sleep quality, treatment benefit, and comfort for both groups (p = 0.316, p = 0.300, and p = 0.557, respectively). CONCLUSION High pressure was more effective in reducing subcutaneous tissue thickness in the dorsum of hand and arm. The usage of high-pressure can be recommended especially in cases which have edema in the dorsum of hand and arm which is difficult to resolve. Also, high-pressure bandage can provide faster edema resolution and can be used in rapid volume reduction as desired. Treatment outcomes may improve with high-pressure bandage without any impairment in comfort, sleep quality, and treatment benefit. TRIAL REGISTRATION NUMBER AND DATE NCT05660590, 12/26/2022 retrospectively registered.
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Affiliation(s)
- Elif Duygu-Yildiz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey.
| | - Yesim Bakar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Mustafa Hizal
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Devoogdt N, Thomis S, De Groef A, Heroes AK, Nevelsteen I, Gebruers N, Tjalma WAA, Belgrado JP, Monten C, Hanssens M, De Vrieze T. The Effectiveness of Fluoroscopy-Guided Manual Lymph Drainage as Part of Decongestive Lymphatic Therapy on the Superficial Lymphatic Architecture in Patients with Breast Cancer-Related Lymphoedema: A Randomised Controlled Trial. Cancers (Basel) 2023; 15:cancers15051545. [PMID: 36900336 PMCID: PMC10000864 DOI: 10.3390/cancers15051545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
The objective of this trial was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD), as part of decongestive lymphatic therapy (DLT), on the superficial lymphatic architecture in patients with chronic mild to moderate breast cancer-related lymphoedema (BCRL). This trial was a multicentre, double-blind, randomised controlled trial involving 194 participants with BCRL. Participants were randomised into (1) DLT with fluoroscopy-guided MLD (intervention group), (2) DLT with traditional MLD (control group), or (3) DLT with placebo MLD (placebo group). Superficial lymphatic architecture was evaluated as a secondary outcome, visualised by ICG lymphofluoroscopy at the baseline (B0), post-intensive (P), and post-maintenance phases (P6). Variables were (1) number of efferent superficial lymphatic vessels leaving the dermal backflow region, (2) total dermal backflow score, and (3) number of superficial lymph nodes. The traditional MLD group showed a significant decrease in the number of efferent superficial lymphatic vessels at P (p = 0.026), and of the total dermal backflow score at P6 (p = 0.042). The fluoroscopy-guided MLD and placebo group showed significant decreases in the total dermal backflow score at P (p < 0.001 and p = 0.044, respectively) and at P6 (p < 0.001 and p = 0.007, respectively); the placebo MLD group showed a significant decrease in the total number of lymph nodes at P (p = 0.008). However, there were no significant between-group differences for the changes in these variables. In conclusion, based on lymphatic architecture outcomes, the added value of MLD, in addition to the other parts of DLT, could not be demonstrated in patients with chronic mild to moderate BCRL.
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Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Correspondence:
| | - Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, 2610 Antwerp, Belgium
| | - An-Kathleen Heroes
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, 2610 Antwerp, Belgium
- Multidisciplinary Breast Clinic and Multidisciplinary Oedema Clinic, Antwerp University Hospital, 2650 Antwerp, Belgium
| | - Wiebren A. A. Tjalma
- Multidisciplinary Breast Clinic and Multidisciplinary Oedema Clinic, Antwerp University Hospital, 2650 Antwerp, Belgium
- Department of Medicine, University of Antwerp, MIPRO, 2610 Antwerp, Belgium
| | - Jean-Paul Belgrado
- Lymphology Research Unit, Université libre de Bruxelles, 1070 Brussels, Belgium
| | - Chris Monten
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marianne Hanssens
- Department of Oncology, Centre for Oncology, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, 2610 Antwerp, Belgium
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8
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De Vrieze T, Gebruers N, Nevelsteen I, Thomis S, De Groef A, Tjalma WAA, Belgrado JP, Vandermeeren L, Monten C, Hanssens M, Asnong A, Dams L, Van der Gucht E, Heroes AK, Devoogdt N. Does Manual Lymphatic Drainage Add Value in Reducing Suprafascial Fluid Accumulation and Skin Elasticity in Patients With Breast Cancer-Related Lymphedema? Phys Ther 2022; 102:pzac137. [PMID: 36209432 DOI: 10.1093/ptj/pzac137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/31/2022] [Accepted: 07/10/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD) versus that of traditional and placebo MLD, when added to decongestive lymphatic therapy (DLT) for the treatment of breast cancer-related lymphedema (BCRL) (EFforT-BCRL trial), on the suprafascial accumulation of lymphatic fluid and skin elasticity. METHODS In this multicenter, 3-arm, double-blind, randomized controlled trial (EFforT-BCRL trial), 194 participants (mean age = 61 [SD = 10] years) with unilateral BCRL were recruited. All participants received standardized DLT (education, skin care, compression therapy, exercises) and were randomized to fluoroscopy-guided, traditional, or placebo MLD. Participants received 60 min/d of treatment during the 3-week intensive phase and 18 sessions of 30 minutes during the 6-month maintenance phase. During this phase, participants were instructed to wear a compression garment, to perform exercises, and to perform a self-MLD procedure once daily. This study comprises secondary analyses of the EFforT-BCRL trial. Outcomes were the amount of fluid accumulation in the suprafascial tissues (local tissue water, extracellular fluid, and thickness of the skin and subcutaneous tissue) and skin elasticity at the level of the arm and trunk. Measurements were performed at baseline; after intensive treatment; after 1, 3, and 6 months of maintenance treatment; and after 6 months of follow-up. RESULTS At the level of the arm, there was a significant improvement over time in the 3 groups for most of the outcomes. At the level of the trunk, no remarkable improvement was noted within the individual groups. No significant interaction effects (between-group differences) were present. Only skin elasticity at the level of the arm, evaluated through palpation, showed a significant interaction effect. CONCLUSION All 3 groups showed similar improvements in response to DLT regardless of the type of MLD that was added. The effect of the addition of MLD to other components of DLT for reducing local tissue water and extracellular fluid or skin thickness and for improving skin elasticity and fibrosis in participants with chronic BCRL was limited. IMPACT Although MLD has been applied all over the world for many years, evidence regarding its added value in reducing arm volume in patients with BCRL is lacking. These results show that adding MLD to other components of DLT has limited value in reducing local tissue water and extracellular fluid or skin thickness and in improving skin elasticity and fibrosis in patients with chronic BCRL. To date, there is no clinical indication to continue including time-consuming MLD in physical therapist sessions for patients with chronic BCRL.
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Affiliation(s)
- Tessa De Vrieze
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Nick Gebruers
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
- University of Antwerp and Antwerp University Hospital, Multidisciplinary Oedema Clinic, Antwerp, Belgium
| | - Ines Nevelsteen
- UZ Leuven - University Hospitals Leuven, Multidisciplinary Breast Centre, Leuven, Belgium
| | - Sarah Thomis
- UZ Leuven - University Hospitals Leuven, Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphoedema, Leuven, Belgium
| | - An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Wiebren A A Tjalma
- University of Antwerp and Antwerp University Hospital, Multidisciplinary Oedema Clinic, Antwerp, Belgium
- University of Antwerp, Department of Medicine, MIPRO, Antwerp, Belgium
- Antwerp University Hospital, Multidisciplinary Breast Clinic, Antwerp, Belgium
| | - Jean-Paul Belgrado
- Université Libre de Bruxelles, Lymphology Research Unit, Brussels, Belgium
| | | | - Chris Monten
- Ghent University Hospital, Department of Radiotherapy, Ghent, Belgium
| | - Marianne Hanssens
- General Hospital Groeninge, Department of Oncology, Centre for Oncology, Kortrijk, Belgium
| | - Anne Asnong
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Lore Dams
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Elien Van der Gucht
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - An-Kathleen Heroes
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- UZ Leuven - University Hospitals Leuven, Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphoedema, Leuven, Belgium
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9
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Savla JJ, Kelly B, Krogh E, Smith CL, Krishnamurthy G, Glatz AC, DeWitt AG, Pinto EM, Ravishankar C, Gillespie MJ, O’Byrne ML, Escobar FA, Rome JJ, Hjortdal V, Dori Y. Occlusion Pressure of the Thoracic Duct in Fontan Patients With Lymphatic Failure: Does Dilatation Challenge Contractility? World J Pediatr Congenit Heart Surg 2022; 13:737-744. [DOI: 10.1177/21501351221119394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The Fontan circulation challenges the lymphatic system. Increasing production of lymphatic fluid and impeding lymphatic return, increased venous pressure may cause lymphatic dilatation and decrease lymphatic contractility. In-vitro studies have reported a lymphatic diameter-tension curve, with increasing passive stretch affecting the intrinsic contractile properties of each thoracic duct segment. We aimed to describe thoracic duct occlusion pressure and asses if thoracic duct dilation impairs contractility in individuals with a Fontan circulation and lymphatic failure. Methods Central venous pressure and thoracic duct measurements were retrospectively collected from 31 individuals with a Fontan circulation. Thoracic duct occlusion pressure was assessed during a period of external manual compression and used as an indicator of lymphatic vessel contractility. Measurements of pressure were correlated with measurements of the thoracic duct diameter in images obtained by dynamic contrast-enhanced MR lymphangiography. Results The average central venous pressure and average pressure of the thoracic duct were 17 mm Hg. During manual occlusion, the thoracic duct pressure significantly increased to 32 mm Hg. The average thoracic duct diameter was 3.3 mm. Thoracic duct diameter correlated closely with the central venous pressure. The rise in pressure following manual occlusion showed an inverse correlation with the diameter of the thoracic duct. Conclusion Higher central venous pressures are associated with increasing diameters of the thoracic duct. When challenged by manual occlusion, dilated thoracic ducts display a decreased ability to increase pressure. Dilatation and a resulting decreased contractility may partly explain the challenged lymphatic system in individuals with a Fontan circulation.
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Affiliation(s)
- Jill J. Savla
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin Kelly
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Emil Krogh
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher L. Smith
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, PA, USA
| | - Ganesh Krishnamurthy
- The Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, PA, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew C. Glatz
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron G. DeWitt
- The Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, PA, USA
- Division of Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin M. Pinto
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, PA, USA
| | - Chitra Ravishankar
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, PA, USA
| | - Matthew J. Gillespie
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael L. O’Byrne
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Fernando A. Escobar
- The Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, PA, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan J. Rome
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, PA, USA
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, Rigshospitalet, Aarhus, Denmark
| | - Yoav Dori
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, PA, USA
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10
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Wilting J, Becker J. The lymphatic vascular system: much more than just a sewer. Cell Biosci 2022; 12:157. [PMID: 36109802 PMCID: PMC9476376 DOI: 10.1186/s13578-022-00898-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Almost 400 years after the (re)discovery of the lymphatic vascular system (LVS) by Gaspare Aselli (Asellius G. De lactibus, sive lacteis venis, quarto vasorum mesaraicorum genere, novo invento Gasparis Asellii Cremo. Dissertatio. (MDCXXIIX), Milan; 1628.), structure, function, development and evolution of this so-called 'second' vascular system are still enigmatic. Interest in the LVS was low because it was (and is) hardly visible, and its diseases are not as life-threatening as those of the blood vascular system. It is not uncommon for patients with lymphedema to be told that yes, they can live with it. Usually, the functions of the LVS are discussed in terms of fluid homeostasis, uptake of chylomicrons from the gut, and immune cell circulation. However, the broad molecular equipment of lymphatic endothelial cells suggests that they possess many more functions, which are also reflected in the pathophysiology of the system. With some specific exceptions, lymphatics develop in all organs. Although basic structure and function are the same regardless their position in the body wall or the internal organs, there are important site-specific characteristics. We discuss common structure and function of lymphatics; and point to important functions for hyaluronan turn-over, salt balance, coagulation, extracellular matrix production, adipose tissue development and potential appetite regulation, and the influence of hypoxia on the regulation of these functions. Differences with respect to the embryonic origin and molecular equipment between somatic and splanchnic lymphatics are discussed with a side-view on the phylogeny of the LVS. The functions of the lymphatic vasculature are much broader than generally thought, and lymphatic research will have many interesting and surprising aspects to offer in the future.
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Affiliation(s)
- Jörg Wilting
- Department of Anatomy and Cell Biology, University Medical School Göttingen, Göttingen, Germany.
| | - Jürgen Becker
- Department of Anatomy and Cell Biology, University Medical School Göttingen, Göttingen, Germany
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Antoniak K, Zorena K, Jaskulak M, Hansdorfer-Korzon R, Mrugacz M, Koziński M. Significant Decrease in Glycated Hemoglobin, 2h-Post-Load Glucose and High-Sensitivity C-Reactive Protein Levels in Patients with Abnormal Body Mass Index after Therapy with Manual Lymphatic Drainage. Biomedicines 2022; 10:biomedicines10071730. [PMID: 35885034 PMCID: PMC9313311 DOI: 10.3390/biomedicines10071730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to investigate the effect of manual lymphatic drainage (MLD) on the insulin resistance parameter (HOMA-IR), glycated hemoglobin (HbA1c), C-peptide, insulin, fasting plasma glucose (FPG), 2h-post-loadglucose (2h-PG) and the concentration of high-sensitivity C-reactive protein (hsCRP) in patients with abnormal body mass index. The study involved 30 patients, including patients with normal body weight (as a control group; group I; n = 14), overweight patients (group II; n = 9) and obese patients (group III; n = 7). Each patient underwent 10 sessions of MLD therapy, 3 times a week for 30 min. In addition, we measured body mass index (BMI) and waist-to-hip ratio (WHR) and performed body composition analysis as well as biochemical tests before MLD therapy (stage 0′) and after MLD therapy (stage 1′). A statistically significant correlation was demonstrated between the concentration of C-peptide, BMI, the amount of visceral adipose tissue (r = 0.87, p = 0.003; r = 0.76, p = 0.003, respectively), and the HOMA-IR index, BMI and the amount of visceral adipose tissue (r = 0.86, p = 0.005; r = 0.84, p = 0.042, respectively), before and after MLD therapy. In overweight patients (group II), a statistically significant (p = 0.041) decrease in the hsCRP level by 2.9 mg/L and a significant (p = 0.050) decrease in the 2h-PG level by 12 mg/dL after the MLD therapy was detected. Moreover, in the group of obese patients (group III), a statistically significant (p = 0.013) decrease in HbA1c level by 0.2% after MLD therapy was demonstrated. Our results indicate that MLD may have a positive effect on selected biochemical parameters, with the most favorable changes in overweight patients. Further studies in a larger number of patients are warranted to confirm our findings, to test in-depth their mechanism, and to investigate clinical benefits of this alternative therapy in patients with abnormal body mass index.
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Affiliation(s)
- Klaudia Antoniak
- Department of Immunobiology and Environment Microbiology, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland;
- Correspondence: (K.A.); (K.Z.)
| | - Katarzyna Zorena
- Department of Immunobiology and Environment Microbiology, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland;
- Correspondence: (K.A.); (K.Z.)
| | - Marta Jaskulak
- Department of Immunobiology and Environment Microbiology, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland;
| | - Rita Hansdorfer-Korzon
- Department of Physical Therapy, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland;
| | - Małgorzata Mrugacz
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, Kilinskiego 1, 15-089 Bialystok, Poland;
| | - Marek Koziński
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Faculty of Health Sciences, Medical University of Gdansk, Powstania Styczniowego 9b, 81-519 Gdynia, Poland;
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Holm-Weber T, Kristensen RE, Mohanakumar S, Hjortdal VE. Gravity and lymphodynamics. Physiol Rep 2022; 10:e15289. [PMID: 35586957 PMCID: PMC9117968 DOI: 10.14814/phy2.15289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
The lymphatic system is compromised in different groups of patients. To recognize pathology, we must know what is healthy. We use Near-Infrared Fluorescence (NIRF) to assess peripheral lymphatic function in humans. We have shown that external factors such as exercise, hyperthermia, and pharmacological mediators influence the function of peripheral lymphatic vessels. In this study, we explored the impact on lymphatic vessels by the ever-present external factor-gravity. We used NIRF imaging to investigate the lymphatic changes to gravity. Gravity was assessed by changing body position from supine to standing. We extracted following lymphatic functional parameters: lymphatic packet propulsion frequency (contractions/min), velocity (cm/s), and pressure (mmHg). Raw data analysis was performed using a custom-written Labview program. All sequences were analyzed by two observers and interclass correlation scores were calculated. All statistical analysis was performed using RStudio Team (2021). RStudio: Integrated Development Environment for R. RStudio, PBC. Healthy participants (n = 17, 11 males, age 28.1 ± 2.6 years) were included. The lymphatic packet propulsion frequency at baseline was 0.5 ± 0.2 contractions/min and rose within 3 min significantly to a maximum of 1.2 ± 0.5 contractions/min during upright posture and remained significantly higher than the baseline lymphatic packet propulsion frequency after lying down again for up to 6 min. The lymph velocity was 1.5 ± 0.4 cm/s at baseline and changed in both directions and without a specific pattern at different points in time during standing. Lymph pressure was significantly higher while standing (mean increase 9 mmHg, CI: 2-15 mmHg). The ICC scores were 89.8% (85.9%-92.7%), 59.3% (46.6%-69.6%) and 89.4% (79.0%-94.8%) in lymphatic packet propulsion frequency (130 observations), velocity (125 observations), and pressure (30 observations), respectively. The lymphatic system responds within few minutes to gravitational changes by increasing lymphatic packet propulsion frequency and pressure.
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Affiliation(s)
- Thomas Holm-Weber
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Eskild Kristensen
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sheyanth Mohanakumar
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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De Vrieze T, Gebruers N, Nevelsteen I, Fieuws S, Thomis S, De Groef A, Tjalma WA, Belgrado JP, Vandermeeren L, Monten C, Hanssens M, Devoogdt N. Manual lymphatic drainage with or without fluoroscopy guidance did not substantially improve the effect of decongestive lymphatic therapy in people with breast cancer-related lymphoedema (EFforT-BCRL trial): a multicentre randomised trial. J Physiother 2022; 68:110-122. [PMID: 35428594 DOI: 10.1016/j.jphys.2022.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 01/22/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022] Open
Abstract
QUESTIONS When added to decongestive lymphatic therapy (DLT), what is the effect of fluoroscopy-guided manual lymphatic drainage (MLD) versus traditional MLD or placebo MLD for the treatment of breast cancer-related lymphoedema (BCRL)? DESIGN Multicentre, three-arm, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of assessors and participants. PARTICIPANTS At five hospitals in Belgium, 194 participants with unilateral chronic BCRL were recruited. INTERVENTION All participants received standard DLT (education, skin care, compression therapy and exercises). Participants were randomised to also receive fluoroscopy-guided MLD (n = 65), traditional MLD (n = 64) or placebo MLD (n = 65). Participants received 14 sessions of physiotherapy during the 3-week intensive phase and 17 sessions during the 6-month maintenance phase. Participants performed self-management on the other days. OUTCOME MEASURES All outcomes were measured: at baseline; after the intensive phase; after 1, 3 and 6 months of maintenance phase; and after 6 months of follow-up. The primary outcomes were reduction in excess volume of the arm/hand and accumulation of excess volume at the shoulder/trunk, with the end of the intensive phase as the primary endpoint. Secondary outcomes included daily functioning, quality of life, erysipelas and satisfaction. RESULTS Excess lymphoedema volume decreased after 3 weeks of intensive treatment in each group: 5.3 percentage points of percent excessive volume (representing a relative reduction of 23.3%) in the fluoroscopy-guided MLD group, 5.2% (relative reduction 20.9%) in the traditional MLD group and 5.4% (relative reduction 24.8%) in the placebo MLD group. The effect of fluoroscopy-guided MLD was very similar to traditional MLD (between-group difference 0.0 percentage points, 95% CI -2.0 to 2.1) and placebo MLD (-0.2 percentage points, 95% CI -2.1 to 1.8). Fluid accumulated at the shoulder/trunk in all groups. The average accumulation with fluoroscopy-guided MLD was negligibly less than with traditional MLD (-3.6 percentage points, 95% CI -6.4 to -0.8) and placebo MLD (-2.4 percentage points, 95% CI -5.2 to 0.4). The secondary outcomes also showed no clinically important between-group differences. CONCLUSION In patients with chronic BCRL, MLD did not provide clinically important additional benefit when added to other components of DLT. REGISTRATION NCT02609724.
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Affiliation(s)
- Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium; Multidisciplinary Oedema Clinic, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | | | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Sarah Thomis
- Centre for Lymphedema, Department of Vascular Surgery & Department of Physical Medicine and Rehabilitation, UZ Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Wiebren Aa Tjalma
- Multidisciplinary Oedema Clinic, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium; Department of Medicine University of Antwerp, Antwerp, Belgium; Multidisciplinary Breast Clinic, Antwerp University Hospital, Antwerp, Belgium
| | - Jean-Paul Belgrado
- Lymphology Research Unit, Université libre de Bruxelles, Brussels, Belgium
| | | | - Chris Monten
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Marianne Hanssens
- Centre for Oncology, Department of Oncology, General Hospital Groeninge, Kortrijk, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
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Invention and Clinical Application of an Oversleeve for Measuring Limb Volume in Postoperative Breast Cancer Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5600804. [PMID: 35126628 PMCID: PMC8813221 DOI: 10.1155/2022/5600804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/02/2022]
Abstract
Background Lymphedema is a common complication of breast cancer treatment, affecting 1/5 of breast cancer survivors, but there is no reliable way to detect subclinical lymphedema. Objective The purpose of this study was to determine the feasibility and reliability of using an oversleeve as a postoperative limb volume measurement tool in breast cancer patients. Methods Fifty patients were analyzed based on inclusion criteria. A body volume measurement kit was designed based on the drainage volume method and the circumference measurement method. Twenty-two normal healthy people were measured by the drainage volume (LV) and oversleeve measuring limb volume (OMLV) methods, so as to verify the accuracy of OMLV. Twenty-eight patients with lymphedema diagnosed by the circumdiameter measurement (CDM) method were measured with OMLV for comparison. The difference in measurements between OMLV and CDM was compared in 50 patients with early lymphedema diagnosed by the LV method. Results There was no significant difference between the sleeve method and the drainage volume method in the normal population (P = 0.74). All patients with lymphedema diagnosed by CDM met the diagnostic criteria by the OMLV method. In patients with early lymphedema diagnosed by LV, the diagnostic rate with OMLV was significantly higher than that with CDM (P = 0.008). Conclusion Similar to LV in the diagnosis of lymphedema, OMLV can effectively improve the diagnostic rate of early lymphedema, providing a new option for the diagnosis and treatment of lymphedema.
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Phillips N, Lawrance S, Everett J. Treating chronic oedema of the lower limb using circular knit garments: how garment characteristics affect outcomes. Br J Community Nurs 2021; 26:S22-S28. [PMID: 34542317 DOI: 10.12968/bjcn.2021.26.sup10.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of compression therapy to treat chronic oedema of the lower limbs can be a challenge, especially when this is undertaken by clinicians who have limited experience and knowledge of the theoretical principles which underpin its use in clinical practice. This articles aims to discuss the reasoning which underpins the use of compression hosiery in the management of lymphoedema and how this understanding can improve treatment outcomes and reduce the burden of disease on patients and clinical resources.
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Affiliation(s)
| | - Sue Lawrance
- Lymphoedema Clinical Nurse Specialist, Florence Nightingale Hospice, Aylesbury
| | - Jeanne Everett
- Lymphoedema Clinical Nurse Specialist, St Teresa's Hospice, Darlington
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16
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Antoniak K, Hansdorfer-Korzon R, Mrugacz M, Zorena K. Adipose Tissue and Biological Factors. Possible Link between Lymphatic System Dysfunction and Obesity. Metabolites 2021; 11:metabo11090617. [PMID: 34564433 PMCID: PMC8464765 DOI: 10.3390/metabo11090617] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 12/27/2022] Open
Abstract
The World Health Organization (WHO) has recognised obesity as one of the top ten threats to human health. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of an increased release of biologically active metabolites. Moreover, obesity predisposes the development of metabolic syndrome and increases the incidence of type 2 diabetes (T2DM), increases the risk of developing insulin resistance, atherosclerosis, ischemic heart disease, polycystic ovary syndrome, hypertension and cancer. The lymphatic system is a one-directional network of thin-walled capillaries and larger vessels covered by a continuous layer of endothelial cells that provides a unidirectional conduit to return filtered arterial and tissue metabolites towards the venous circulation. Recent studies have shown that obesity can markedly impair lymphatic function. Conversely, dysfunction in the lymphatic system may also be involved in the pathogenesis of obesity. This review highlights the important findings regarding obesity related to lymphatic system dysfunction, including clinical implications and experimental studies. Moreover, we present the role of biological factors in the pathophysiology of the lymphatic system and we propose the possibility of a therapy supporting the function of the lymphatic system in the course of obesity.
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Affiliation(s)
- Klaudia Antoniak
- Department of Immunobiology and Environment Microbiology, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Rita Hansdorfer-Korzon
- Department of Physical Therapy, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Małgorzata Mrugacz
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, Kilinskiego 1, 15-089 Białystok, Poland;
| | - Katarzyna Zorena
- Department of Immunobiology and Environment Microbiology, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
- Correspondence: ; Tel./Fax: +48-583491765
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17
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Iannello C, Biller MK. Management of edema using simple manual lymphatic drainage techniques for hand and upper extremity patients. J Hand Ther 2021; 33:616-619. [PMID: 30975621 DOI: 10.1016/j.jht.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/22/2018] [Indexed: 02/03/2023]
Affiliation(s)
| | - Marcy K Biller
- St. Joseph's Hospital, Outpatient Occupational Therapy Department, Tampa, FL, USA
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18
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Thomis S, Helberg M, Kleiman J, De Vrieze T, Heroes AK, Fourneau I, Devoogdt N. The Interrater Reliability of the Scoring of the Lymphatic Architecture and Transport Through Near-InfraRed Fluorescence Lymphatic Imaging in Patients with Breast Cancer-Related Lymphedema. Lymphat Res Biol 2021; 20:133-143. [PMID: 34077678 DOI: 10.1089/lrb.2020.0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Of the 1.38 million women who are diagnosed every year with breast cancer worldwide, 21% will develop arm lymphedema. Near-infrared fluorescence lymphatic imaging (NIRFLI) is an effective method for real-time evaluation of the lymphatic system. Reliability studies of the scoring of this NIRFLI are lacking. The aim of this study is to investigate if evaluation of the superficial lymphatic architecture and transport in patients with breast cancer-related lymphedema through NIRFLI can be performed in a reliable way. Methods and Results: The outcome parameters used to assess agreement were the presence of lymphatic transport from the injection sites, of dermal backflow patterns, of efferent lymphatic vessels, and of lymph nodes. The NIRFLI evaluations were scored before and after a break separately by two assessors. Twenty patients with lymphedema of the arm and/or hand were included. After the injection, there was weak to very strong agreement regarding the presence of transport from the injection sites (K = 0.459-1.000). The interpretation of the type of dermal backflow pattern varied from weak (WK = 0.452) to very strong agreement (WK = 1.000) between the two assessors. Agreement in the visualization of efferent lymphatic vessels was weak before and after the break (K = 0.490 and K = 0.571) and agreement regarding the presence of lymph nodes was very strong (K = 1.000). Conclusion: Overall, there was moderate to strong agreement between the assessors when evaluating the lymphatic architecture and transport through NIRFLI. The study has been registered at clinicaltrials.gov (NCT02609724).
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Affiliation(s)
- Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium.,Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Melissa Helberg
- Berekuyl Academy and European College of Decongestive Lymphatic Therapy, Harderwijk, The Netherlands
| | - Jantine Kleiman
- Berekuyl Academy and European College of Decongestive Lymphatic Therapy, Harderwijk, The Netherlands
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - An-Kathleen Heroes
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium.,Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
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Gogia SB, Rekha A, Sood S. Chronic Lymphedema Management: Case Series Analysis of 9 Years from a Specialized Clinic in Delhi. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chen WF, Tuncer FB, Zeng W. Advanced Technical Pearls for Successful Supermicrosurgical Lymphaticovenular Anastomosis. Ann Plast Surg 2021; 86:S165-S172. [PMID: 33443891 DOI: 10.1097/sap.0000000000002689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
ABSTRACT Lymphaticovenular anastomosis (LVA) is now accepted as one of the mainstays of surgical treatment of lymphedema. The unique advantages of LVA that set it apart from other procedures such as vascularized lymph node transfer are its safety and its minimally invasive nature. To date, there has been no report of worsening of disease as a result of LVA, even when performed unsuccessfully. Despite these notable advantages, the procedure is much less frequently performed compared with vascularized lymph node transfer because of inconsistent procedural outcome. In our experience, LVA is highly effective when performed with proper patient selection and meticulous technical execution. In this article, we share the senior author's LVA "tips and tricks" to help readers achieve greater success when performing this extraordinary supermicrosurgical procedure.
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Affiliation(s)
- Wei F Chen
- From the Center for Lymphedema Research and Reconstruction, Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Fatma Betul Tuncer
- From the Center for Lymphedema Research and Reconstruction, Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Weifeng Zeng
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, WI
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Yoshida S, Koshima I, Imai H, Uchiki T, Sasaki A, Fujioka Y, Nagamatsu S, Yokota K, Yamashita S. Modified intraoperative distal compression method for lymphaticovenous anastomosis with high success and a low venous reflux rates. J Plast Reconstr Aesthet Surg 2021; 74:2050-2058. [PMID: 33541824 DOI: 10.1016/j.bjps.2020.12.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 11/08/2020] [Accepted: 12/26/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION For successful lymphaticovenous anastomosis (LVA), it is important to create anastomoses with high flow to maintain patency. To ensure that this can be achieved, we compared the efficacy of a modified intraoperative distal compression (IDC) technique with the conventional no compression (NC) method for lower limb lymphedema. PATIENTS AND METHODS In the IDC group, compression was applied to an area of the foot distal to the first LVA site. After completion of the first LVA, the distal compression was extended over the first LVA site to the distal end of the second LVA site. RESULTS There was no significant difference between the IDC (n = 25) and NC (n = 25) groups in detection rate. However, significant differences were observed in lymphatic vessel diameter and LVA success rate. No intraoperative anastomotic obstruction was seen at the conclusion of surgery. Intraoperative congestion with blood was detected in lymphatic vessels in 8 of 79 anastomoses (10.1%) in the NC group, but not in any cases in the IDC group (p = 0.002). There was a significant between-group difference in the rate of improvement in lymphedema between the IDC (16.1±3.6) and NC groups (14.0±3.4; p = 0.03). DISCUSSION IDC during LVA is thought to increase lymph flow in larger caliber lymphatics, leading to a high success rate and a low rate of venous reflux. IDC is beneficial when performing LVA.
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Affiliation(s)
- Shuhei Yoshida
- The International Center for Lymphedema, Hiroshima University Hospital, Japan.
| | - Isao Koshima
- The International Center for Lymphedema, Hiroshima University Hospital, Japan
| | - Hirofumi Imai
- The International Center for Lymphedema, Hiroshima University Hospital, Japan
| | - Toshio Uchiki
- Plastic and reconstructive Surgery, Hiroshima University, Japan
| | - Ayano Sasaki
- Plastic and reconstructive Surgery, Hiroshima University, Japan
| | - Yumio Fujioka
- Plastic and reconstructive Surgery, Hiroshima University, Japan
| | - Shogo Nagamatsu
- Plastic and reconstructive Surgery, Hiroshima University, Japan
| | - Kazunori Yokota
- Plastic and reconstructive Surgery, Hiroshima University, Japan
| | - Shuji Yamashita
- Plastic and Reconstructive Surgery, The University of Tokyo, Japan
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22
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Thomis S, Dams L, Fourneau I, De Vrieze T, Nevelsteen I, Neven P, Gebruers N, Devoogdt N. Correlation Between Clinical Assessment and Lymphofluoroscopy in Patients with Breast Cancer-Related Lymphedema: A Study of Concurrent Validity. Lymphat Res Biol 2020; 18:539-548. [DOI: 10.1089/lrb.2019.0090] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
- Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven–University of Leuven, Leuven, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
- Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven–University of Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Oedema Clinic, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Nele Devoogdt
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
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Donahue PMC, Crescenzi R, Lee C, Garza M, Patel NJ, Petersen KJ, Donahue MJ. Magnetic resonance imaging and bioimpedance evaluation of lymphatic abnormalities in patients with breast cancer treatment-related lymphedema. Breast Cancer Res Treat 2020; 183:83-94. [PMID: 32601969 PMCID: PMC8086787 DOI: 10.1007/s10549-020-05765-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Breast cancer treatment-related lymphedema (BCRL) evaluation is frequently performed using portable measures of limb volume and bioimpedance asymmetry. Here quantitative magnetic resonance imaging (MRI) is applied to evaluate deep and superficial tissue impairment, in both surgical and contralateral quadrants, to test the hypothesis that BCRL impairment is frequently bilateral and extends beyond regions commonly evaluated with portable external devices. METHODS 3-T MRI was applied to investigate BCRL topographical impairment. Female BCRL (n = 33; age = 54.1 ± 11.2 years; stage = 1.5 ± 0.8) and healthy (n = 33; age = 49.4 ± 11.0 years) participants underwent quantitative upper limb MRI relaxometry (T2), bioimpedance asymmetry, arm volume asymmetry, and physical evaluation. Parametric tests were applied to evaluate study measurements (i) between BCRL and healthy participants, (ii) between surgical and contralateral limbs, and (iii) in relation to clinical indicators of disease severity. Two-sided p-value < 0.05 was required for significance. RESULTS Bioimpedance asymmetry was significantly correlated with MRI-measured water relaxation (T2) in superficial tissue. Deep muscle (T2 = 37.6 ± 3.5 ms) and superficial tissue (T2 = 49.8 ± 13.2 ms) relaxation times were symmetric in healthy participants. In the surgical limbs of BCRL participants, deep muscle (T2 = 40.5 ± 4.9 ms) and superficial tissue (T2 = 56.0 ± 14.8 ms) relaxation times were elevated compared to healthy participants, consistent with an edematous micro-environment. This elevation was also observed in contralateral limbs of BCRL participants (deep muscle T2 = 40.3 ± 5.7 ms; superficial T2 = 56.6 ± 13.8 ms). CONCLUSIONS Regional MRI measures substantiate a growing literature speculating that superficial and deep tissue, in surgical and contralateral quadrants, is affected in BCRL. The implications of these findings in the context of titrating treatment regimens and understanding malignancy recurrence are discussed.
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Affiliation(s)
- Paula M C Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Dayani Center for Health and Wellness, Nashville, TN, USA
| | - Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea Lee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maria Garza
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J Patel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kalen J Petersen
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Kelly B, Mohanakumar S, Telinius N, Alstrup M, Hjortdal V. Function of Upper Extremity Human Lymphatics Assessed by Near-Infrared Fluorescence Imaging. Lymphat Res Biol 2020; 18:226-231. [DOI: 10.1089/lrb.2019.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Benjamin Kelly
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sheyanth Mohanakumar
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Niklas Telinius
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Alstrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Vibeke Hjortdal
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Experimental Drainage Device to Reduce Lymphoedema in a Rat Model. Eur J Vasc Endovasc Surg 2019; 57:859-867. [DOI: 10.1016/j.ejvs.2018.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/22/2018] [Indexed: 12/11/2022]
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Gennaro P, Gabriele G, Aboh IV, Cascino F, Zerini F, Aboud MG. Ultramicrosurgery: A new approach to treat primary male genital lymphedema. JPRAS Open 2019; 20:72-80. [PMID: 32158873 PMCID: PMC7061607 DOI: 10.1016/j.jpra.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background Lymphedema is a chronic pathology characterized by progressive swelling due to lymphatic dysfunction (1). Literature contains few studies that focus on male genital lymphedema. A variety of surgical techniques as part of the male genital lymphedema therapeutic strategy has been described. Supramicrosurgical lymphatico-venular anastomosis s-LVA, based on connecting lymphatic collectors to venules, has evidenced efficient outcomes thus far. However, the peculiarity of the genital area may lead to an innovative and even more accurate surgical technique as a treatment of male genital lymphedema: lymphatic pre-collectors located superficially over the fascial layer can be used to perform the ultramicrosurgical anastomosis. Purpose of the study In this paper, the authors report their experience of this new surgical concept based on anastomosing lymphatic precollectors to venules. Methods We performed a retrospective study from 2014 to 2016. Six male patients with primary genital lymphedema underwent ultramicrosurgical lymphatico-venular anastomosis in Siena University Hospital, Italy. Results Ultramicrosurgical lymphatico-venular anastomosis has evidenced positive outcomes in terms of prognosis, infectious complications, volume reduction, and quality of life. The average cellulitis rate dropped from 2.5 episodes a year to 0.5 episodes after surgical intervention. The mean satisfaction index passed from 1.33 before the intervention to 2.83. Conclusion Ultramicrosurgical lymphatico-venular anastomosis represents a challenging physiological approach for male genital lymphedema with promising outcomes.
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Affiliation(s)
- P Gennaro
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - G Gabriele
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - I V Aboh
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - F Cascino
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - F Zerini
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - M G Aboud
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Phillips JJ, Gordon SJ. Intermittent Pneumatic Compression Dosage for Adults and Children with Lymphedema: A Systematic Review. Lymphat Res Biol 2019; 17:2-18. [DOI: 10.1089/lrb.2018.0034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- J. Jane Phillips
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Plastic Surgery Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan J. Gordon
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomised trial. J Physiother 2018; 64:245-254. [PMID: 30241913 DOI: 10.1016/j.jphys.2018.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/08/2018] [Accepted: 08/07/2018] [Indexed: 01/22/2023] Open
Abstract
QUESTION What are the short-term and long-term preventive effects of manual lymph drainage (MLD), when used in addition to information and exercise therapy, on the development of lymphoedema after axillary dissection for breast cancer? DESIGN Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS Adults undergoing unilateral dissection for breast cancer were recruited, with 79 allocated to the experimental group and 81 to the control group. INTERVENTION The experimental group received guidelines about prevention of lymphoedema, exercise therapy and MLD. The control group received the same guidelines and exercise therapy, but no MLD. The interventions in both groups were delivered for 6 months. OUTCOME MEASURES The primary outcome was cumulative incidence of arm lymphoedema defined in four ways (≥200ml,≥2cm,≥5%, and≥10% increase), which represent the difference in arm volume or circumference between the affected and healthy sides compared with the difference before surgery. Secondary outcomes included point prevalence of lymphoedema, change in arm volume difference, shoulder range of movement, quality of life and function. RESULTS Incidence rates were comparable between experimental and control groups at all follow-up measurements. Sixty months after surgery, the cumulative incidence rate for the≥200ml definition was 35% for the experimental group versus 29% for the control group (RR 0.89, 95% CI 0.51 to 1.54, p=0.45); for the≥2cm definition 35% versus 38% (RR 0.93, 95% CI 0.59 to 1.45, p=0.73); for the≥5% definition 68% versus 53% (RR 1.28, 95% CI 0.97 to 1.69, p=0.08) and for the≥10% definition 28% versus 24% (RR 1.18, 95% CI 0.66 to 2.10, p=0.57). The secondary outcomes were comparable between the groups at most assessment points. CONCLUSION Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the short and long term. TRIAL REGISTRATION Netherlands Trial Register NTR 1055. [Devoogdt N, Geraerts I, Van Kampen M, De Vrieze T, Vos L, Neven P, Vergote I, Christiaens M-R, Thomis S, De Groef A (2018) Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomised trial. Journal of Physiotherapy 64: 245-254].
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De Vrieze T, Gebruers N, Devoogdt N. Can manual lymph drainage be improved or not: That's the question! A response letter. Eur J Obstet Gynecol Reprod Biol 2018; 229:200-202. [PMID: 30029825 DOI: 10.1016/j.ejogrb.2018.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tessa De Vrieze
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Nick Gebruers
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium; University of Antwerp & Antwerp University Hospital, Multidisciplinary Oedema Clinic, Antwerp, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; UZ Leuven - University Hospitals Leuven, Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphoedema, Leuven, Belgium.
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Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, Tjalma W. Prediction formulas to determine breast cancer treatment related lymphedema do have a clinical relevance. Eur J Obstet Gynecol Reprod Biol 2018; 225:256-257. [PMID: 29680686 DOI: 10.1016/j.ejogrb.2018.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Nick Gebruers
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of rehabilitation sciences and physiotherapy, MOVANT research group, Universiteitsplein 1, 2610 Wilrijk, Belgium; Multidisciplinary Oedema Clinic, University of Antwerp and Antwerp University hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Antwerp University Hospital, Multidisciplinary breast clinic, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - Hanne Verbelen
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of rehabilitation sciences and physiotherapy, MOVANT research group, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Tessa De Vrieze
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of rehabilitation sciences and physiotherapy, MOVANT research group, Universiteitsplein 1, 2610 Wilrijk, Belgium; KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Herestraat 49, 3000 Leuven, Belgium.
| | - Lore Vos
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Herestraat 49, 3000 Leuven, Belgium.
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Herestraat 49, 3000 Leuven, Belgium; University Hospitals Leuven, Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Lymphovenous Centre, Herestraat 49, B-3000 Leuven, Belgium.
| | - Lore Fias
- Multidisciplinary Oedema Clinic, University of Antwerp and Antwerp University hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Antwerp University Hospital, Department of Thorax and Vascular Surgery, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - Wiebren Tjalma
- Multidisciplinary Oedema Clinic, University of Antwerp and Antwerp University hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Department of Medicine, Universiteitsplein 1, 2610 Wilrijk, Belgium; Antwerp University Hospital, Multidisciplinary breast clinic, Wilrijkstraat 10, 2650 Edegem, Belgium.
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De Vrieze T, Vos L, Gebruers N, Devoogdt N. Letter to the editor. Br J Community Nurs 2018; 23:S34. [PMID: 29906196 DOI: 10.12968/bjcn.2018.23.sup4.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Tessa De Vrieze
- PhD student, University of Leuven and University of Antwerp, Belgium
| | - Lore Vos
- PhD student, University of Leuven and University of Antwerp, Belgium
| | - Nick Gebruers
- Professor of Rehabilitation Sciences and Physiotherapy, University of Antwerp, and Physiotherapist, Multidisciplinary Oedema Clinic, Antwerp University Hospital, Belgium
| | - Nele Devoogdt
- Professor of Rehabilitation Sciences and Physiotherapy, University of Leuven, and Physiotherapist, Lymphovenous Centre, University Hospitals Leuven, Belgium
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Protocol of a randomised controlled trial regarding the effectiveness of fluoroscopy-guided manual lymph drainage for the treatment of breast cancer-related lymphoedema (EFforT-BCRL trial). Eur J Obstet Gynecol Reprod Biol 2017; 221:177-188. [PMID: 29277358 DOI: 10.1016/j.ejogrb.2017.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Lymphoedema is a dreadful complication following breast cancer therapy. According to the International Society of Lymphology, the consensus treatment for breast cancer-related lymphoedema (BCRL) is the decongestive lymphatic therapy. This is a two-phase treatment and combines different treatment modalities including skin care, manual lymphatic drainage (MLD), compression therapy and exercise. However, the additional effect of MLD is debated since pooled data only demonstrated a limited non-significant additional value. A possible explanation is that in previous studies MLD has been applied blind, without knowledge of patient-specific lymphatic routes of transport. In addition, the MLD hand manoeuvres used by the therapists in previous studies, possibly did not optimally stimulate lymphatic transport. Recently, near-infrared fluorescence imaging has been introduced to visualise the superficial lymphatic network which allows MLD at the most needed location. The aim of the present study is to determine the effectiveness of the fluoroscopy-guided MLD, additional to the other parts of the decongestive lymphatic therapy and compared to the traditional or a placebo MLD, in the treatment of BCRL. STUDY DESIGN A three-arm double-blinded randomised controlled trial will be conducted in different university hospitals in Belgium. Based on a sample size calculation, 201 participants with chronic BCRL stage 1 or 2 of the arm or hand, with at least 5% difference between both sides (corrected for hand dominance) need to be recruited. All participants receive the standard treatment: skin care, compression therapy and exercises. The intervention group additionally receives fluoroscopy-guided MLD. One control group additionally receives the traditional 'blind' MLD and a second control group receives a placebo MLD. All subjects receive 3 weeks of daily intensive treatments and 6 months of maintenance treatment. Follow-up period is 6 months. The primary outcomes are the reduction in lymphoedema volume of the arm/hand and the change in stagnation of lymph fluid at level of the shoulder/trunk.
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Abstract
Lymphoedema management has evolved over many decades, but the core components of treatment remain largely unaltered, such as skin care, compression and self-lymphatic drainage. Near-infrared fluorescence lymphatic imaging (NIRFLI) offers an opportunity to enhance patient outcomes by evaluating and increasing the effectiveness of these treatment options. This is relevant when we consider the impact of this chronic condition and its endemic proportions ( Mortimer, 2014 ), while Moffatt et al (2017) suggests it is one of the biggest health risks in the Western world, due to the multiple causes, such as cancer, obesity and as a complication of an ageing population. The impact of the condition can be reduced through early identification and the risk-reduction strategies that NIRFLI can offer through greater understanding of its chronicity. The use of NIRFLI has also led to the development of a new manual lymphatic drainage technique to assist in the management of lymphoedema ( Belgrado et al, 2016 ). The aim of this article is to introduce and describe NIRFLI and its use within lymphoedema management. It will discuss use with early detection of lymphoedema and expand further, focusing on its use within the management of lymphoedema.
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Affiliation(s)
- Jane Wigg
- Clinical Consultant and Director, Lymphoedema Training Academy, and LymphVision Staffordshire
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Lee N, Pugh S, Cooper R. Haddenham easywrap as part of self-management in lymphoedema and lipoedema: The patient perspective. Br J Community Nurs 2017; 22:S50-S57. [PMID: 28961045 DOI: 10.12968/bjcn.2017.22.sup10.s50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Self-management and the use of adjustable velcro compression wraps are not new concepts and quite often both can form part of the maintenance phase of treatment in those with lymphoedema or lipoedema, as well as those diseases in which compression therapy is advised as long-term management. The aim of this article is to identify some aspects that contribute to effective self-management and how the use of easywrap adjustable velcro compression wraps have improved quality of life for those with lymphoedema, chronic oedema and lipoedema. Case studies are given from patients to demonstrate the individual experience of living with lymphoedema or lipoedema, how this has impacted on daily life, and how using easywrap has helped as part of self-management.
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Affiliation(s)
| | - Stacy Pugh
- Palliative Care Lymphoedema Clinical Nurse Manager, Wolverhampton Lymphoedema Service, Compton Hospice; Honorary Lecturer, University of Wolverhampton; Trainer at Lymphoedema Training Academy
| | - Robin Cooper
- Vascular/Lymphoedema Nurse Specialist, Salisbury District Hospital
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Lopera C, Worsley PR, Bader DL, Fenlon D. Investigating the Short-Term Effects of Manual Lymphatic Drainage and Compression Garment Therapies on Lymphatic Function Using Near-Infrared Imaging. Lymphat Res Biol 2017; 15:235-240. [DOI: 10.1089/lrb.2017.0001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Catalina Lopera
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter R Worsley
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Dan L Bader
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Deborah Fenlon
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, Tjalma W. Current and future perspectives on the evaluation, prevention and conservative management of breast cancer related lymphoedema: A best practice guideline. Eur J Obstet Gynecol Reprod Biol 2017; 216:245-253. [DOI: 10.1016/j.ejogrb.2017.07.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/02/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
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Loskotová A, Loskotová J, Suchanek I, Brychta P, Lipový B. Myofascial-manual lymphatic drainage for burn trauma: a service evaluation. Br J Community Nurs 2017; 22 Suppl 5:S6-S12. [PMID: 28467220 DOI: 10.12968/bjcn.2017.22.sup5.s6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Improving microcirculation in the area of a wound is an important aspect of wound healing. It can be improved by a new manual methodology: myofascial-manual lymphatic drainage (M-MLD). This hybrid technique uses elements of musculoskeletal medicine and manual lymphatic drainage. Through palpation, M-MLD therapeutically affects the functional pathology of soft tissues, with reflection in trigger points, and also the functional pathology of lymphatic system, namely by lymphostasis in particular regional lymph nodes. Most cases of post-traumatic and postoperative conditions lead to dynamic insufficiency of the venous system and subsequently of the lymphatic system. If this is not treated promptly, it can lead to secondary post-traumatic lymphoedema. Early M-MLD treatment eliminates the development of secondary post traumatic lymphoedema and even secondary inflammation, thus decreasing the risk of cicatrix hypertrophy and contributing to faster wound healing and better regeneration of the afflicted area. Laboratory immunological examination of circulating immune complexes support 20 years of the authors' empirical experience. The level of circulating immune complexes before M-MLD reached constant values. After manual influencing of the functional pathology of soft tissue and lymphatic system, the dynamics of circulating immune complexes levels was observed, this is the effect of the improvement of microcirculation in the wound area. M-MLD is time- and cost-saving, but it requires professional training with a very good palpation technique. In the authors' experience, its use is indicated within 2-24 hours from the time of trauma (surgery), and then once a day until healing is achieved. This early manual therapeutic treatment can be delivered not only by physiotherapists, but also nurses working to encourage wound healing, such as in traumatology, surgery and orthopaedics. Using M-MLD makes the total treatment time shorter, and has an economical, biopsychosocial and society-wide impact.
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Affiliation(s)
- Anna Loskotová
- Chief of Department of Physiotherapy, Masaryk University Brno
| | - Jitka Loskotová
- Doctoral student, Faculty of Law, Department of Public Finance, lymphterapeut, Clinic of Physiotherapy, Vysoké Mýto
| | - Ivan Suchanek
- Vice Chief, Department of Burns and Reconstructive Surgery, University Hospital Brno-Bohunice
| | - Pavel Brychta
- Professor, Medical Faculty, Masaryk University Brno, Chief of Department of Burns and Reconstructive Surgery, University Hospital Brno-Bohunice
| | - Bretislav Lipový
- Assistant Professor, Department of Burns and Reconstructive Surgery, University Hospital Brno-Bohunice
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Effectiveness of Self–Lymphatic Drainage? REHABILITATION ONCOLOGY 2017. [DOI: 10.1097/01.reo.0000000000000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Belgrado JP. Reply to "Near-Infrared Fluorescence Lymphatic Imaging to Reconsider Occlusion Pressure of Superficial Lymphatic Collectors in Upper Extremities of Health Volunteers: Facts and/or Artifacts" by Pierre Bourgeois and Romain Barbieux. Lymphat Res Biol 2017; 15:109-113. [PMID: 28323567 DOI: 10.1089/lrb.2016.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jean-Paul Belgrado
- Lymphology Research Unit, Université Libre de Bruxelles , Bruxelles, Belgium
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Bourgeois P, Barbieux R. "Near-Infrared Fluorescence Lymphatic Imaging to Reconsider Occlusion Pressure of Superficial Lymphatic Collectors in Upper Extremities of Healthy Volunteers": Facts and/or Artifact? Lymphat Res Biol 2017; 15:107-108. [PMID: 28323570 DOI: 10.1089/lrb.2016.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Affiliation(s)
- Jane Wigg
- Director, Lymphoedema Training Academy and LymphVision; Clinical Consultant, Haddenham Healthcare; and Non-executive Director, LymphCare UK
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Cooper G. A wealth of information to apply to lymphoedema management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:200-202. [PMID: 28230433 DOI: 10.12968/bjon.2017.26.4.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Garry Cooper, Lecturer in Adult Nursing and Lymphoedema, Birmingham City University, considers how increasing knowledge in the field needs to be translated into effective, patient-focused services.
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Lee N, Wigg J, Pugh S, Barclay J, Moore H. Lymphoedema management with the LymphFlow Advance pneumatic compression pump. Br J Community Nurs 2016; 21:S13-S19. [PMID: 27715144 DOI: 10.12968/bjcn.2016.21.sup10.s13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There are many intermittent pneumatic compression devices available for use in the management and adjunct treatment of lymphatic, venous and arterial disease. This article discusses the development of a new advanced pneumatic compression device, the LymphFlow Advance, which can perform focussed treatment on the lymphoedematous area using a variety of different cycles. Case studies with therapist and patient feedback are used to demonstrate the use of the LymphFlow Advance in the lymphoedema clinic, with a discussion of the evidence to underpin recommended treatment regimes.
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Affiliation(s)
| | - Jane Wigg
- Director, Lymphoedema Training Academy
| | - Stacy Pugh
- Lymphoedema Clinical Nurse Manager, Wolverhampton Lymphoedema Service
| | - Janet Barclay
- Lymphoedema Nurse Specialist, Dorset Lymphoedema Clinic
| | - Hayley Moore
- Macmillan Lymphoedema Nurse Specialist, Barnstaple Lymphoedema Service
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Abstract
Ageing affects not only individuals but also society. It occurs throughout the western world. The ageing process may lead to the development of conditions, such as chronic oedema, as well as comorbidities such as osteoarthritis. These comorbidities can make the management of chronic oedema even more difficult. This is an especially important consideration when tailoring individualised care plans, such as exercise, as conditions such as rheumatoid arthritis can limit patients' ability to manage their oedema. Despite challenges, education can improve patient outcomes when evidence-based practice is used.
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Affiliation(s)
- Garry Cooper
- Lecturer and Practitioner, Compton Hospice Education & Training Centre, Wolverhampton
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